The outcome of interest in this study was autism, specifically ASD [International Classification of Mental and Behavioral Disorders version 10 (ICD-10) diagnosis codes starting with F84] and childhood autism (ICD-10 diagnosis code F84.0) only. ASD comprises all pervasive developmental disorders. It is characterized by one or more of the following areas of neurodivergence: qualitative variations in patterns of communication; difficulties with reciprocal social interactions; and a restricted, repetitive collection of behaviors and interests. For childhood autism, symptoms within all three areas of neurodivergence must be present before the age of 3 years.
When a child is suspected of having autism in Scania, they are referred to the Departments of Child and Adolescent Psychiatry and are examined by a multidisciplinary team42 (link). These evaluations utilize both the Autism Diagnostic Observation Schedule-Generic (ADOS-G)43 (link) and the Autism Diagnostic Interview-Revised (ADI-R)44 (link) for most (75%) cases. Diagnostic methods for the remaining cases can differ. On occasion, structured instruments other than ADOS and ADI, such as the Mini-International Neuropsychiatric Interview for Children and Adolescents (MINI Kid), the Kiddie Schedule for Affective Disorders and Schizophrenia (K-SADS), the Social Communication Questionnaire (SCQ), the Social Responsiveness Scale, 2nd Edition (SRS-2), the Child Behavior Checklist (CBCL), or the Nordic Questionnaire for Evaluation of Development and Behavior in Children and Adolescents called Five-to-Fifteen (5–15 or FTF), are used to varying degrees and in varying combinations. In all cases, however, the child’s behavior is observed, the parents are interviewed, and information is gathered from the child’s school. All data is then evaluated and compared to diagnostic criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM). Finally, an autism diagnosis is assigned according to the ICD-10 and entered into the Skåne Healthcare Database (SHR). The outcome data used in this study was extracted from SHR and was available through the 31st of December, 2017.
When a child is suspected of having autism in Scania, they are referred to the Departments of Child and Adolescent Psychiatry and are examined by a multidisciplinary team42 (link). These evaluations utilize both the Autism Diagnostic Observation Schedule-Generic (ADOS-G)43 (link) and the Autism Diagnostic Interview-Revised (ADI-R)44 (link) for most (75%) cases. Diagnostic methods for the remaining cases can differ. On occasion, structured instruments other than ADOS and ADI, such as the Mini-International Neuropsychiatric Interview for Children and Adolescents (MINI Kid), the Kiddie Schedule for Affective Disorders and Schizophrenia (K-SADS), the Social Communication Questionnaire (SCQ), the Social Responsiveness Scale, 2nd Edition (SRS-2), the Child Behavior Checklist (CBCL), or the Nordic Questionnaire for Evaluation of Development and Behavior in Children and Adolescents called Five-to-Fifteen (5–15 or FTF), are used to varying degrees and in varying combinations. In all cases, however, the child’s behavior is observed, the parents are interviewed, and information is gathered from the child’s school. All data is then evaluated and compared to diagnostic criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM). Finally, an autism diagnosis is assigned according to the ICD-10 and entered into the Skåne Healthcare Database (SHR). The outcome data used in this study was extracted from SHR and was available through the 31st of December, 2017.
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